Examples: Primary Angioplasty for Myocardial Infarction (PAMI)

St. Vincent's Medical Center, Bridgeport, Conn.

The Primary Angioplasty for Myocardial Infarction (PAMI) program was developed in 1996. The catalyst for the program was the chairperson of cardiology who was interested in providing immediate percutaneous coronary intervention (PCI) as an alternative to thrombolytic therapy for those patients experiencing myocardial infarction (MI). The potential benefits include reduced mortality, reduced cost, decreased use of critical care beds, decreased length of stay and community perception of St. Vincent's as a center for excellence in cardiac care.

Implementation of the PAMI program was an interdisciplinary process. After intensive planning, a PAMI protocol and pathway were developed. The hallmark of the PAMI program is to offer intervention 24/7 for all patients who have symptoms of MI. The PAMI team is comprised of an interventional cardiologist, cardiac catheterization lab (cath lab) registered nurse (RN) and radiology tech. The PAMI team is activated when the protocol guidelines are met. The goal for treatment is to provide PCI within one hour of the activation of the team.

Program Implementation

Implementation of the PAMI program was an interdisciplinary process. This process included participation from the medical staff, emergency department, cath lab, nursing services, case management, nutrition services, patient access, communications and pastoral care. In the planning stages, attention to communication between departments and understanding of the PAMI protocol was critical.

In the review of our one-year outcomes, it was evident that PAMI was a good practice model for the care of patients with MI:

• Use of thrombolytics was eliminated, resulting in lower costs and less complications



• In comparison to thrombolytics, PAMI reduced mortality by 8 percent and length of stay by four days for MI patients

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